Endovascular treatment for acute ischemic stroke in patients with versus without atrial fibrillation: a matched-control study

Abstract

Background and objective The effect of atrial fibrillation (AF) on outcomes of endovascular treatment (EVT) for acute ischemic stroke (AIS) is controversial. This study aimed to investigate the association of AF with outcomes after EVT in AIS patients. Methods Subjects were selected from ANGEL-ACT registry (Endovascular Treatment Key Technique and Emergency Work Flow Improvement of Acute Ischemic Stroke) - a prospective consecutive cohort of AIS patients undergoing EVT at 111 hospitals in China between November 2017 and March 2019, and then grouped according to having a history of AF or not. After 1:1 propensity score matching, the outcome measures including the 90-day modified Rankin Scale (mRS) score, successful recanalization after final attempt, symptomatic intracranial hemorrhage (ICH) within 24 h, and death within 90 days were compared. Results A total of 1755 patients, 550 with AF and 1205 without AF, were included. Among 407 pairs of patients identified after matching, no significant differences were found in the mRS score (median: 3 vs. 3 points; P = 0.29), successful recanalization (87.2 vs. 85.3%; P = 0.42), symptomatic ICH (9. 4 vs. 9.1%; P = 0.86) and death (16.3 vs. 18.4%; P = 0.44) between patients with and without AF. Conclusion The findings of this matched-control study show comparable outcomes of EVT in Chinese AIS patients with and without AF, which do not support withholding EVT in patients with both AIS and AF. Trial registration NCT03370939 First registration date: 28/09/2017 First posted date: 13/12/2017

Outcomes in patients with ischaemic stroke undergoing endovascular thrombectomy: Impact of atrial fibrillation

“…5,[14][15][16] Similar to the present study, two previous retrospective observational studies in the United States (n = 562 AF vs 572 non-AF) and China (n = 407) used 1:1 propensity score matching in patients with and without AF demonstrated no significant difference in ICH (at 1-day and 90 days), mortality or good functional status at 90 days. 17,18 The present analyses further supports evidence from previous observational studies showing that presence of AF did not impact on the rate of ICH or all-cause mortality within 90 days of follow-up in patients with ischaemic stroke who underwent EVT, when compared to ischaemic stroke patients without AF.…”

Endovascular treatment of acute basilar artery occlusion in patients with and without atrial fibrillation: results from the ATTENTION registry

“…A subsequent meta-analysis from the HERMES collaboration and the ANGEL-ACT registry trials supported no significant interaction effect between AF and functional outcomes at 90 days after EVT. 14 , 19 Here, our study showed that EVT had similar effects on AF and non-AF patients, whereby AF status should not influence clinical decision to conduct thrombectomy for acute BAO patients.…”

“…To consistent with previous reports on EVT in anterior circulation, we found no association between AF and 90-day functional outcomes for patients with acute BAO. Accumulating evidence in patients with anterior circulation occlusions supported the neutral association between AF and long-term functional outcomes after EVT, 14 , 19 and limiting evidence from studies focused on BAO patients also supported this neutral association. 20 – 24 …”

“…No determined association between AF and hemorrhage transformation could be drawn in AIS patients after reperfusion therapy. 19 , 18 , 25 – 27 However, the absolute risk of sICH after EVT due to BAO remains low. 16 , 17 , 28 The ATTENTION registry trial suggests that EVT should not be abandoned for fears of post-treatment hemorrhagic transformation regardless of AF status.…”

The Impact of Atrial Fibrillation on the Outcome of Ischemic Stroke Treated With Thrombolysis or Endovascular Therapy

“…Another meta-analysis of 18 studies reported worse outcomes in AF versus non-AF cases of ischemic stroke treated with thrombolysis and higher incidence of sICH in patients with AF treated with thrombolysis compared to the other therapies [16]. On the other hand, Tong et al reported no significant differences in the mRS score, successful recanalization, sICH and mortality between patients with and without AF after EVT [17]. In contrast, Zhang et al found that patients with stroke and AF may benefit from tPA in terms of 90-day follow-up [18].…”